OPSEU Diablogue

When James Martin, a former program facilitator at Whitby Mental Health Centre (now Ontario Shores Centre for Mental Health Sciences) sent a letter to the Minister for Child and Youth Services asking about funding for the hospital’s adolescent programs, the Honourable Laurel Broten sent him a tersely worded letter suggesting he instead contact the Central East Local Health Integration Network.

The funding is linked to plans affecting an adolescent residential rehab program that the hospital has run for more than 40 years. Youth from across the province with three to seven prior hospitalizations are admitted to the program. In the past it has claimed success with teens for which the mental health system was a revolving door.

When Martin did just that, asking for a record of consultations undertaken by the hospital and evidence to support the changes, he received a letter back from James Meloche, a Senior Director at the CE LHIN.

Instead of giving Martin what he asked for, the LHIN told him that Ontario Shores had “engaged in an extensive review of their Adolescent Inpatient Services through a process that included dialogue and input from community healthcare providers, users of Ontario Shores Services, hospitals, community agencies, Ministry of Child and Youth Services, school boards, family services, as well as representatives from the Child and Youth Worker profession at Ontario Shores.”

Meloche also omitted answering his question regarding clinical evidence.

In fact, we had heard this before – from Ontario Shores itself. It’s almost word-for-word from a letter sent by Glenna Raymond in December to Keith Lindsay, President of the Ontario Association of Child and Youth Counsellors.

Our local has asked for the specific consultations and evidence-based practices for weeks. They were told it had to be prepared, even though one would have to wonder why evidence used to make a decision had to be prepared AFTER the decision was made?

This week we tried again to access a detailed record of the consultations and evidence from the Central East LHIN. We were politely told that Ontario Shores would be willing to provide it to us. We still don’t have it.

Remarkably, Ontario Shores told OPSEU’s steward on the unit the delay is because the evidence and consultation list had to be instead given to the communications department to deal with the adverse publicity surrounding changes to the units. Have they never heard of the photocopier?

Meanwhile, time is ticking on the layoffs of 28 Child and Youth workers, who will be finished by mid-April.

When we contacted the American Academy of Child and Adolescent Psychiatry – purportedly the source of this evidence according to a Dr. Wilansky-Traynor – they said they too would like to know what evidence Ontario Shores is using from their organization.

Reviewing the AACAPs guidelines for adolescent residential care, it is hard to make the connection between its recommendations and Ontario Shores’ decision to layoff CYCs, merge the short and long stay programs, and reduce access to the long stay program.  

Even though this program is not covered under the accountability agreement between the LHIN and the hospital, the Meloche letter does acknowledge that the LHIN was “apprised of the service changes.” So why are they so reluctant to share what they know or ask needed questions?

Given the LHINs were created to look at the big picture in regional health care planning, why is it they are so hands-off when it comes to a program that is province-wide in scope? The long stay program is the only one of its kind in Ontario.

Further, why is no one asking why a group of Child and Youth Workers, who are among the list of consulted, are unaware of being consulted? In fact, the workers tell us they cannot find anyone who admits to being consulted on the specific changes to the long stay program. That includes referral hospitals and agencies to the program.

And of course, as we have seen before, consulting does not necessarily involve listening.

In the letter from CEO Glenna Raymond to Keith Lindsay, she says the consultation was about increasing access to specialized assessment, stabilization and treatment services – in other words, making more short stay beds available. That’s very different from consulting on whether to effectively gut a long-stay adolescent residential rehab program that has had success for more than 40 years.

It’s time the Minister of Health and the Minister of Child and Youth Services put a stop to this nonsense and demand some real answers from Ontario Shores.

NDP leader Andrea Horwath has issued a release questioning the decision to layoff 28 highly trained child and youth counsellors at Whitby’s Ontario Shores Centre for Mental Health Sciences.

 “The McGuinty government acknowledges there is a crisis in mental health funding and has promised to fix the problems,” says Horwath. “Why is the government idle while drastic cuts are being made to the very services families need for treating their child’s mental health issues?”

Horwath, who is the NDP’s critic for Children and Youth Services, is calling for cancellation of the layoffs and protection of the existing adolescent residential rehab program.

“It appears as though the stage is being set to reduce and replace longer term residential services with short-term and outpatient programs,” she says. “For the young patients and their families, this marks a return to the ‘revolving door’ of services that experts in the field decry.”

Several prominent child psychiatrists have been critical of Ontario Shores over changes to the program, including replacing the child and youth counsellors with a smaller number of nurses, most of them RPNs. One of them, Dr. Gabrielle Ledger, resigned her post over the changes.

To read Andrea Horwath’s letter to the Minister of Health and Long Term Care, the Minister of Child and Youth Services, and the Chair of the Central East LHIN, click here:

http://www.opseu.org/news/press2010/jan-10-2011-hcrelease-letters.htm

WHITBY – Changes to Ontario Shores’ adolescent program are 30 years out-of-date says Dr. Gabrielle Ledger, a Bowmanville psychiatrist who quit her job last month at the Whitby psychiatric hospital.

In a public letter, Ledger says she quit her job at Ontario Shores Centre for Mental Health Sciences as a direct result of changes being implemented there.

In December Ontario Shores issued layoff notices to about half of its child and youth workers as part of a merger of the short and long-stay adolescent programs. The long-stay adolescent residential rehab (ARR) program has successfully worked with youth from across the province that have had between three and seven prior hospitalizations.

“In my opinion, this proposed change reflects the hospital’s attempt to apply an adult model of mental health services to a non-adult population,” she writes. “This is a significant step backwards towards a model that is thirty years out of date.”

Ontario Shores plans on replacing about 28 child and youth workers with nursing staff providing a very different model of care.

Ledger says the adolescent programs at Ontario Shores are staffed by an experienced team of professionals who have collaborated for more than 25 years.

“Unfortunately the recent decision made by the administrators of this newly divested hospital suggests that they may be unaware of the history of the programs and the careful evolution that occurred before their tenure at Ontario Shores.”

Ledger is not the first health professional to speak about the move.

Dr. Krista Lemke, Medical Director of Child and Adolescent Mental Health Services a the Toronto East General Hospital, stated in a December letter that while nursing staff are equally essential team members and contribute their own unique skills, they often require additional training in child and adolescent mental health.

Lemke writes: “From a human resources perspective, this was a well-functioning team, capable of providing high quality care to a particularly vulnerable population of adolescents. It saddens me greatly to hear that this unique team no longer seems to be valued and may be largely disbanded.”

The complete text of the letters is available at http://www.opseu.org/news/press2010/jan-10-2011-hcrelease-letters.htm.

The Full text of Dr. Ledger’s Letter:

 Dec 26, 2010

To whom it may concern:

I am writing to outline my significant concerns regarding the changes underway in the Adolescent Program at the Ontario Shores Centre for Mental Health Sciences. I was previously the staff psychiatrist on the adolescent Assessment, Stabilization, Treatment and Transition (ASTT) program from September 2009 until December 2010. I resigned from my position as a direct result of the changes currently being implemented in this program.

My colleague, Dr. Krista Lemke, Medical Director of Child and Adolescent Mental Health Services at Toronto East General Hospital has recently written a letter outlining her concern that the impact of the changes underway in the Adolescent Program at Ontario Shores will be felt throughout the continuum of children’s mental health services in the province. I share her concerns and hope to expand on them in this letter.

As of December 13, 2010, the administrators of Ontario Shores have declared their intention to replace two thirds of the current frontline staff, Child and Youth Counsellors, with nurses. As a specialist in the field of children’s mental health, I am keenly aware of the differences in training and expertise of these two groups of professionals. They serve unique but complimentary roles in delivering high quality health care for our provinces most vulnerable youth. Their roles, however, do not overlap to the extent that one group can be replaced by the other. I fear that those proposing this exchange are insufficiently aware of the specifics involved in caring for mentally ill children. In my opinion, this proposed change reflects the hospital’s attempt to apply an adult model of mental health services to a non-adult population. This is a significant step backwards towards a model that is thirty years out of date; the child and youth counsellor representatives in inpatient children’s mental health programs are the product of a long, healthy evolution.

Another significant change already implemented in the adolescent inpatient programs at Ontario Shores concerns the elimination of half of the social work positions. This occurred in early 2010 and was the first decision that shook my confidence in the decision-makers at Ontario Shores. Inpatient adolescent mental health programs utilize social workers intensively. The most unwell young people admitted to psychiatric hospitals in Ontario deserve expert assessments of the family dynamics affecting their illness and their recovery. Once again, applying an adult mental health social work staffing model to youth is inappropriate.

Finally, the decision to eliminate the longer term Adolescent Residential Rehabilitation (ARR) program at Ontario Shores further reflects a lack of understanding of the unique function of this highly specialized program within the province. The program offers young people diagnosed with illnesses such as schizophrenia an opportunity to attempt a gradual reintegration to life outside the hospital setting by building a bridge to the rest of the world. Programming in ARR (designed by the child and youth counsellors) facilitated a progressive and successful return to social, family and academic functioning outside of the institution, but within the safety of the hospital and prevented repeated “bounce-backs” when young people return to crisis and require readmission. Sadly, one gradual but successful attempt at reintegration is less financially rewarding to institutions reliant on “results-based funding” wherein the revolving door pays.

The adolescent programs at Ontario shores are staffed by highly skilled, extremely experienced teams of professionals, some of whom have collaborated for over 25 years to carefully craft the best treatment for the most marginalized and most vulnerable youth. Unfortunately, the recent decisions made by the administrators of this newly divested hospital suggests that they may be unaware of the history of the programs and the careful evolution that occurred before their tenure at Ontario Shores. It saddens and concerns me that the transformation of the adolescent programs at Ontario Shores may be taking place without benefitting from a sophisticated understanding of the past, present and future of adolescent mental health.

Sincerely, Gabrielle Ledger, MD, FRCPC